Basic Information
| Provider Information | |||||||||
| NPI: | 1164951778 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENSEN | ||||||||
| FirstName: | CHAD | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5310 KIETZKE LN STE 104 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895112043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753488800 | ||||||||
| FaxNumber: | 7753488818 | ||||||||
| Practice Location | |||||||||
| Address1: | 973 MICA DR STE 201 | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897057258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757836190 | ||||||||
| FaxNumber: | 7753488818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2017 | ||||||||
| LastUpdateDate: | 06/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | R-10932 | IA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.